Tensions mount over King/Drew

Restoring federal funding to troubled Martin Luther King Jr./Drew Medical Center may be more difficult than county leaders anticipated, judging from the tenor of communications this week between officials here and in Washington.

First, federal regulators sent a pointed letter to the county’s health chief, raising more than a dozen tough questions about the soundness of the MetroCare plan to save the hospital and asking for a slew of details on timelines, costs and state support.

Then the health chief, sounding slightly exasperated, fired back a 19-page reply, contending that the county had already supplied much of the information and asking to meet with the nation’s top Medicare officials in person -- a request that he said had previously been rebuffed.

“There really needs to be some face-to-face, direct negotiations,” Supervisor Yvonne Brathwaite Burke, whose district includes the hospital, said Friday. “That’s the only way I think you can get something this complex handled.”

County and federal officials are under pressure because there is little time to act: The hospital in Willowbrook, south of Watts, failed a critical inspection last month and stands to lose $200 million in Medicare funds, nearly half its budget, by Dec. 1.

To prevent the surrounding community from going without vital care, county officials this month proposed a sweeping reduction of services that would keep some of King/Drew open but shift management to another county hospital, Harbor-UCLA Medical Center.

Now they are racing to convince regulators that problems leading to lapses in patient care at King/Drew have been resolved, so the federal money will be restored.

“To the extent that there’s some tension in the letter, it really kind of gets to the point that every day this lingers, we get closer to the brink of a healthcare emergency here in Los Angeles,” county health chief Dr. Bruce Chernof said in an interview Friday.

The exchange comes not long before a Nov. 6 public hearing to discuss the King/Drew cuts.

The letter from Medicare state operations Director Dennis Smith also asks for a date when King/Drew will again meet patient-care requirements and for a detailed explanation of a $50-million bid for transitional funds.

Chernof responded that the money would go toward “information technology and the continuing education” of residents at the affiliated Charles R. Drew University of Medicine and Science -- which alone could cost $40 million -- in addition to patient transfer costs.

Chernof said Friday that transitional expenses will far exceed $50 million and that the figure is just a down payment on future work. The county’s focus, he said, remains on keeping the $200 million in federal money flowing without interruption.

The proposed plan is final, Chernof’s letter says, and changes made in problem areas at the hospital, including infection control and the pharmacy, have made the medical center safe.

Federal officials also asked if the county had sought the $50-million grant from state or nonfederal sources, to which Chernof responded: “no.” Burke said she also supports seeking state help with the funds.

“The fundamental questions raised in the body of your letter are directly answered in the MetroCare plan, and I believe they point to the need for a face-to-face meeting,” Chernof wrote. “I am dismayed that” the U.S. Centers for Medicare and Medicaid Services “has not accepted my request for a meeting, which was contained in the department’s Oct. 19, 2006, letter.” Chernof also told federal officials that answers to several questions, including dates for future federal inspections, were included in the original plan.

“I wanted to make sure they had carefully read the entire document,” Chernof said Friday. “Clearly, this plan is not about painting walls and moving furniture; it’s a radical overhaul of an entire hospital. I don’t mind being asked critical questions.”

Burke said leadership changes at the Medicare agency and the resulting lack of familiarity with the King/Drew situation have contributed to the misunderstandings.

“That is really something we’ve suffered from,” Burke said. “It couldn’t have been at a worse time.” The supervisor hopes to meet with local, state and federal officials to work out the details, she said. Federal officials did not return calls seeking comment.

While much of Washington is distracted by the upcoming elections, the county “has a hard reality in front of us, which is the Nov. 6 hearing,” Chernof said. If both sides meet in person next week as hoped, there’s a good likelihood the county will have a federal response before the hearing, Chernof said.

Supervisor Don Knabe is not concerned about the federal questions and considers them a standard part of the planning process, according to spokesman David Sommers. “We have yet to hear yes or no on the plan; to speculate on anything else is inappropriate at this point,” Sommers said.

Supervisor Mike Antonovich has “full confidence in Dr. Chernof’s judgment,” spokesman Tony Bell said. “We will defer to the department director on how best to deal with” federal officials.

Supervisors Gloria Molina and Zev Yaroslavsky declined to comment.

Democratic Sens. Barbara Boxer and Dianne Feinstein sent a letter to federal health officials Friday, urging them to back the MetroCare plan in time for the public hearing.

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